ACE2-Targeted Compositions and Methods for Treating COVID-19

ABSTRACT

This invention provides a monoclonal antibody that (i) specifically binds to the extracellular portion of human angiotensin converting enzyme 2 (hACE2); (ii) specifically inhibits binding of SARS-CoV-2 to the extracellular portion of hACE2; and (iii) does not significantly inhibit the ability of hACE2 to cleave angiotensin II and/or a synthetic MCA-based peptide. This invention also provides related recombinant AAV vectors, recombinant AAV particles, compositions, prophylactic and therapeutic methods, and kits.

This application claims the benefit of U.S. Provisional Application No. 63/008,988, filed Apr. 13, 2020; U.S. Provisional Application No. 63/017,159, filed Apr. 29, 2020; U.S. Provisional Application No. 63/028,627, filed May 22, 2020; U.S. Provisional Application No. 63/028,639, filed May 22, 2020; U.S. Provisional Application No. 63/029,765, filed May 26, 2020; and U.S. Provisional Application No. 63/029,772, filed May 26, 2020, the contents of all of which are incorporated herein by reference.

Throughout this application, various publications are cited. The disclosure of these publications is hereby incorporated by reference into this application to describe more fully the state of the art to which this invention pertains.

SEQUENCE LISTING

The instant application contains a Sequence Listing which has been submitted electronically in ASCII format and is hereby incorporated by reference in its entirety. Said ASCII copy, created on May 21, 2021, is named Maddon-4PCT_SL.txt and is 27,481 bytes in size.

FIELD OF THE INVENTION

The present invention relates to monoclonal antibodies and related engineered viruses useful for therapeutically and prophylactically addressing SARS-CoV-2 infection.

BACKGROUND OF THE INVENTION

Since the beginning of the COVID-19 outbreak, there has been—and continues to be—an intensive worldwide effort to develop effective anti-SARS-CoV-2 therapeutics and prophylactics. To date, this nascent effort has yielded a few effective vaccines, but little success otherwise. For at least this reason, there is an urgent need for an effective way to treat and prevent SARS-CoV-2 infection.

SUMMARY OF THE INVENTION

This invention provides a monoclonal antibody that (i) specifically binds to the extracellular portion of human angiotensin converting enzyme 2 (hACE2); (ii) specifically inhibits binding of SARS-CoV-2 to the extracellular portion of hACE2; and (iii) does not significantly inhibit the ability of hACE2 to cleave angiotensin II and/or a synthetic MCA-based peptide.

This invention also provides an isolated nucleic acid molecule encoding (i) the complete light chain, or a portion of the light chain, of the present monoclonal antibody, and/or (ii) the complete heavy chain, or a portion of the heavy chain, of the present monoclonal antibody. This invention further provides a recombinant vector comprising the present nucleic acid molecule operably linked to a promoter of RNA transcription. This invention still further provides a host vector system comprising one or more of the present vectors in a suitable host cell.

This invention further provides a composition comprising (i) the present monoclonal antibody, and (ii) a pharmaceutically acceptable carrier.

This invention still further provides a method for reducing the likelihood of a human subject's becoming infected with SARS-CoV-2 comprising administering to the subject a prophylactically effective amount of the present monoclonal antibody. This invention also provides a method for treating a human subject who is infected with SARS-CoV-2 comprising administering to the subject a therapeutically effective amount of the present monoclonal antibody.

This invention provides (a) a recombinant AAV vector comprising a nucleic acid sequence encoding a heavy chain and/or a light chain of the present monoclonal antibody; (b) a recombinant AAV particle comprising the present recombinant AAV vector; and (c) a composition comprising (i) a plurality of the present AAV particles and (ii) a pharmaceutically acceptable carrier.

This invention provides (a) a method for reducing the likelihood of a human subject's becoming infected with SARS-CoV-2 comprising administering to the subject a prophylactically effective number of the present AAV particles; and (b) a method for treating a human subject who is infected with SARS-CoV-2 comprising administering to the subject a therapeutically effective number of the present AAV particles.

Finally, this invention provides (a) a first kit comprising, in separate compartments, (i) a diluent and (ii) a suspension of the present monoclonal antibody; (b) a second kit comprising, in separate compartments, (i) a diluent and (ii) the present monoclonal antibody in lyophilized form; and (c) a third kit comprising, in separate compartments, (i) a diluent and (ii) a suspension of a plurality of the present recombinant AAV particles.

BRIEF DESCRIPTION OF THE FIGURES

FIG. 1

This figure sets forth the amino acid sequence of hACE2, as well as the nucleic acid sequence encoding it (Tipnis, et al.). Figure discloses SEQ ID NOS 11-12, respectively, in order of appearance.

FIG. 2

This figure sets forth the nucleotide and predicted amino acid sequence of human TMPRSS2 (GenBank Accession No. U75329). The potential initiation methionine codon and the translation stop codon are bold and underlined. The trapped sequences are underlined (for example the trapped sequence HMC26A01 extending from nucleotide 740 to 955). The different domains of the predicted polypeptide are dotted underlined (for example the SRCR domain extends from amino acid residue 148 to 242). The locations of the introns are shown with arrows. (Figure from, and text adapted from, FIG. 1 of A. Paoloni-Giacobino, et al.) Figure discloses SEQ ID NOS 13-14, respectively, in order of appearance.

FIG. 3

This figure sets forth the characterization of SARS-CoV-2 RBD. It shows multiple sequence alignment of RBDs of SARS-CoV-2, SARS-CoV, and MERS-CoV spike (S) proteins. GenBank accession numbers are QHR63250.1 (SARS-CoV-2 S), AY278488.2 (SARS-CoV S), and AFS88936.1 (MERS-CoV S). Variable amino acid residues between SARS-CoV-2 and SARS-CoV are highlighted in dark grey (cyan), and conserved residues among SARS-CoV-2, SARS-CoV, and MERS-CoV are highlighted in light grey (yellow). Asterisks represent fully conserved residues, colons represent highly conserved residues, and periods represent lowly conserved residues. (Figure from, and text adapted from, FIG. 1(a) of Tai, et al.). Figure discloses SEQ ID NOS 15-17, respectively, in order of appearance.

FIG. 4

This figure shows a schematic diagram of an expression cassette for inclusion in an AAV-antibody vector.

DETAILED DESCRIPTION OF THE INVENTION

This invention provides certain antibodies and monoclonal antibody-encoding recombinant viral vectors, related viral particles, and related methods for inhibiting and treating SARS-CoV-2-infection.

Definitions

In this application, certain terms are used which shall have the meanings set forth as follows.

As used herein, “administer”, with respect to monoclonal antibodies, means to deliver the antibodies to a subject's body via any known method suitable for that purpose. Specific modes of administration include, without limitation, intravenous administration, intramuscular administration, and subcutaneous administration. Similarly, as used herein, “administer”, with respect to recombinant viral particles, means to deliver the particles to a subject's body via any known method suitable for that purpose. Specific modes of administration include, without limitation, intravenous administration, intramuscular administration, and subcutaneous administration.

In this invention, monoclonal antibodies can be formulated using one or more routinely used pharmaceutically acceptable carriers. Such carriers are well known to those skilled in the art. For example, injectable drug delivery systems include solutions containing salts (e.g., sodium chloride and sodium phosphate). In a specific embodiment, the injectable drug delivery system comprises monoclonal antibody (e.g., 100 mg, 200 mg, 300 mg, 400 mg, or 500 mg) in the form of a lyophilized powder in a multi-use vial, which is then reconstituted and diluted in, for example, 0.9% Sodium Chloride Injection, USP. In another specific embodiment, the injectable drug delivery system comprises monoclonal antibody (e.g., 100 mg/50 ml, 200 mg/50 ml, 300 mg/50 ml, 400 mg/50 ml, or 500 mg/50 ml) in the form of a suspension in a single-use vial, which is then withdrawn and diluted in, for example, 0.9% Sodium Chloride Injection, USP. Injectable drug delivery systems also include suspensions, gels, microspheres and polymeric injectables, and can comprise excipients such as solubility-altering agents (e.g., ethanol, propylene glycol, and sucrose) and polymers (e.g., polycaprylactones and PLGAs).

In addition, in this invention, recombinant viral particles can be formulated using one or more routinely used pharmaceutically acceptable carriers. Such carriers are well known to those skilled in the art. For example, injectable drug delivery systems include solutions containing salts (e.g., sodium chloride and sodium phosphate) and surfactants (e.g., a poloxamer). In a specific embodiment, the injectable drug delivery system comprises an aqueous solution of sodium chloride (e.g., 180 mM), sodium phosphate (e.g., 10 mM), and a poloxamer (e.g., 0.001% Poloxamer 188). Injectable drug delivery systems also include suspensions, gels, microspheres and polymeric injectables, and can comprise excipients such as solubility-altering agents (e.g., ethanol, propylene glycol, and sucrose) and polymers (e.g., polycaprylactones and PLGAs).

As used herein, the term “antibody” includes, without limitation, (a) an immunoglobulin molecule comprising two heavy chains (i.e., H chains, such as μ, δ, γ, α and ε) and two light chains (i.e., L chains, such as λ and κ) and which recognizes an antigen; (b) polyclonal and monoclonal immunoglobulin molecules; (c) monovalent (e.g., Fab) and divalent fragments thereof, and (d) bispecific forms thereof. Immunoglobulin molecules may derive from any of the commonly known classes, including but not limited to IgA, secretory IgA, IgG and IgM. IgG subclasses are also well known to those in the art and include, but are not limited to, human IgG1, IgG2, IgG3 and IgG4 (preferably, in this invention, IgG2, IgG4, or a combination of IgG2 and IgG4). Antibodies can be both naturally occurring and non-naturally occurring. Furthermore, antibodies include chimeric antibodies, wholly synthetic antibodies, single chain antibodies (e.g., scFv), and fragments thereof. Antibodies may contain, for example, all or a portion of a constant region (e.g., an Fc region) and a variable region, or contain only a variable region (responsible for antigen binding). Antibodies may be human, humanized, chimeric, or nonhuman. Methods for designing and making human and humanized antibodies are well known (See, e.g., Chiu and Gilliland; Lafleur, et al.). Antibodies include, without limitation, the present monoclonal antibodies as defined herein.

As used herein, “CDR3” shall mean complementarity-determining region 3.

As used herein, “effector function”, with respect to an antibody, includes, without limitation, antibody-dependent cell-mediated cytotoxicity (ADCC), antibody-dependent cellular phagocytosis (ADCP), and complement fixation.

As used herein, the present monoclonal antibody binds to an hACE2 “epitope” comprising a given amino acid residue if, for example, that residue directly contacts (e.g., via a hydrogen bond) at least one amino acid residue in the antibody's paratope.

As used herein, a subject who has been “exposed” to SARS-CoV-2 includes, for example, a subject who experienced a high-risk event (e.g., one in which he/she came into contact with the bodily fluids of an infected human subject, such as by inhaling droplets of virus-containing saliva or touching a virus-containing surface). In one embodiment, this exposure occurs two weeks, one week, five days, four days, three days, two days, one day, six hours, two hours, one hour, or 30 minutes prior to receiving the subject prophylaxis.

As used herein, “human angiotensin converting enzyme 2”, also referred to herein as “hACE2”, shall mean (i) the protein having the amino acid sequence set forth in FIG. 1 ; or (ii) a naturally occurring human variant thereof.

As used herein, a “human subject” can be of any age, gender, or state of co-morbidity. In one embodiment, the subject is male, and in another, the subject is female. In another embodiment, the subject is co-morbid (e.g., afflicted with diabetes, asthma, and/or heart disease). In a further embodiment, the subject is not co-morbid. In still another embodiment, the subject is younger than 60 years old. In yet another embodiment, the subject is at least 60 years old, at least 65 years old, at least 70 years old, at least 75 years old, at least 80 years old, at least 85 years old, or at least 90 years old.

As used herein, “human TMPRSS2”, also referred to herein as “hTMPRSS2”, shall mean (i) the protein having the amino acid sequence set forth in FIG. 2 ; or (ii) a naturally occurring human variant thereof. Human TMPRSS2 is also known in the art as epitheliasin, and as transmembrane protease, serine 2. hTMPRSS2 cleaves the SARS-CoV-2 S protein. Without wishing to be bound by any particular theory of hTMPRSS2 function, it is believed that hTMPRSS2 cleaves SARS-CoV-2 S protein at an “S1/S2” cleavage site (i.e., between amino acid residues R685 and S686) and an “S2′” cleavage site (i.e., between amino acid residues R815 and S816). See, e.g., Coutard, et al.

As used herein, a subject is “infected” with a virus if the virus is present in the subject. Present in the subject includes, without limitation, present in at least some cells in the subject, and/or present in at least some extracellular fluid in the subject. In one embodiment, the virus present in the subject's cells is replicating. A subject who is exposed to a virus may or may not become infected with it.

Heavy chain modifications that “inhibit half antibody formation” in IgG4 are described, for example, in C. Dumet, et al. They include, without limitation, the following, with numbering according to the EU Index: (i) S228P; (ii) the mutation combination S228P/R409K; and (iii) K447del and the mutation combination S228P/K447del. Related heavy chain modifications that solve the heavy chain-mispairing problem include, for example, the “knobs-into-holes” (kih) modifications described in M. Godar, et al., and WO/1996/027011.

As used herein, a “long serum half-life”, with respect to a monoclonal antibody, is a serum half-life of at least five days (preferably as measured in vivo in a human, but which may also be measured, for example, in mice, rats, rabbits, and monkeys (e.g., rhesus monkeys, cynamolgous macaques, and marmosets)). In a preferred embodiment, a monoclonal antibody has a long serum half-life if its half-life is at least 15 days, at least 20 days, at least 25 days, at least 30 days, at least 35 days, at least 40 days, at least 45 days, at least 50 days, at least 55 days, at least 60 days, at least 65 days, at least 70 days, at least 75 days, at least 80 days, at least 85 days, at least 90 days, at least 95 days, or at least 100 days. In another preferred embodiment, a monoclonal antibody has a long serum half-life if its half-life is from 15 days to 20 days, from 20 days to 25 days, from 25 days to 30 days, from 30 days to 35 days, from 35 days to 40 days, from 40 days to 45 days, from 45 days to 50 days, from 50 days to 55 days, from 55 days to 60 days, from 60 days to 65 days, from 65 days to 70 days, from 70 days to 75 days, from 75 days to 80 days, from 80 days to 85 days, from 85 days to 90 days, from 90 days to 95 days, from 95 days to 100 days, or over 100 days. Examples of IgG heavy chain modifications that increase half-life relative to corresponding wild-type IgG heavy chains (such as those that increase antibody binding to FcRn) are described in C. Dumet, et al. and G. J. Robbie, et al. They include, without limitation, the following, with numbering according to the EU Index: (i) point mutations at position 252, 254, 256, 309, 311, 433, 434, and/or 436, including the “YTE” mutation combination M252Y/S254T/T256E (U.S. Pat. No. 7,083,784); (ii) the “LS” mutation combination M428L/N434S (WO/2009/086320); (iii) the “QL” mutation combination T250Q/M428L; and (iv) the mutation combinations M428L/V308F and Q311V/N434S.

As used herein, a monoclonal antibody having a “low effector function” includes, without limitation, (i) a monoclonal antibody that has no effector function (e.g., by virtue of having no Fc domain), and (ii) a monoclonal antibody that has a moiety (e.g., a modified Fc domain) possessing an effector function lower than that of a wild-type IgG1 antibody. Monoclonal antibodies having a low effector function include, for example, a monoclonal IgG4 antibody (e.g., a monoclonal IgG4 antibody having heavy chains engineered to reduce effector function relative to wild-type IgG4 heavy chains). Examples of IgG4 heavy chain modifications that lower effector function relative to wild-type IgG4 heavy chains are described in C. Dumet, et al. They include, without limitation, the following, with numbering according to the EU Index: (i) L235E (WO/1994/028027); (ii) L235A, F234A, and G237A (WO/1994/029351 and WO/1995/026403); (iii) D265A (U.S. Pat. No. 7,332,581); (iv) L328 substitution, A330R, and F243L (WO/2004/029207); (v) IgG2/IgG4 format wherein IgG2 (up to T260) is joined to IgG4 (WO/2005/007809); (vi) F243A/V264A combination (WO/2011/149999); (vii) E233P/F234A/L235A/G236del/G237A combination (WO/2017/079369); and (viii) S228P/L235E combination.

As used herein, the “normal function” of hACE2 includes, without limitation, at least one of the following: (i) the ability to convert angiotensin II to angiotensin-(1-7) (i.e., by enzymatically cleaving the C-terminal phenylalanine residue from angiotensin II to form angiotensin-(1-7)); (ii) the ability to cleave [des-Arg]-bradykinin (also known as [des-Arg⁹]-bradykinin); (iii) the ability to hydrolyze Aβ-43 to yield Aβ-42; (iv) the ability to convert angiotensin I to angiotensin-(1-9); (v) the ability to cleave neurotensin; (vi) the ability to cleave kinetensin; (vii) the ability to cleave a synthetic MCA-based peptide; (viii) the ability to cleave apelin-13; and (ix) the ability to cleave dynorphin A 1-13. In one embodiment, the normal function of hACE2 means (i) the ability to convert angiotensin II to angiotensin-(1-7); (ii) the ability to cleave [des-Arg]-bradykinin; (iii) the ability to hydrolyze AR-43 to yield Aβ-42; (iv) the ability to convert angiotensin I to angiotensin-(1-9); (v) the ability to cleave neurotensin; (vi) the ability to cleave kinetensin; (vii) the ability to cleave a synthetic MCA-based peptide; (viii) the ability to cleave apelin-13; and (ix) the ability to cleave dynorphin A 1-13. In a preferred embodiment, the normal function of hACE2 means the ability to convert angiotensin II to angiotensin-(1-7). By way of example, hACE2 activity can be measured using angiotensin II as a substrate to yield angiotensin-(1-7) according to known methods using known reagents, as described in the examples below. hACE2 activity can also be measured using a synthetic MCA-based peptide (e.g., a Mc-Ala/Dnp fluorescence resonance energy transfer (FRET) peptide that yields Mc-Ala upon cleavage by hACE2) according to known methods using known reagents, as described in the examples below.

As used herein, a “prophylactically effective amount” of the present monoclonal antibodies includes, without limitation, (i) 5 mg, 10 mg, 15 mg, 20 mg, 25 mg, 30 mg, 35 mg, 40 mg, 45 mg, 50 mg, 60 mg, 70 mg, 80 mg, 90 mg, 100 mg, 150 mg, 200 mg, 250 mg, 300 mg, 350 mg, 400 mg, 450 mg, or 500 mg; (ii) 5 mg to 20 mg, 20 mg to 50 mg, 50 mg to 100 mg, 100 mg to 200 mg, 200 mg to 300 mg, 300 mg to 400 mg, or 400 mg to 500 mg; (iii) 1 mg/kg, 2 mg/kg, 3 mg/kg, 4 mg/kg, 5 mg/kg, 6 mg/kg, 7 mg/kg, 8 mg/kg, 9 mg/kg, 10 mg/kg, 15 mg/kg, 20 mg/kg, 25 mg/kg, 30 mg/kg, 35 mg/kg, 40 mg/kg, 45 mg/kg, or 50 mg/kg; or (iv) 1 mg/kg to 10 mg/kg, 10 mg/kg to 20 mg/kg, 20 mg/kg to 30 mg/kg, 30 mg/kg to 40 mg/kg, or 40 mg/kg to 50 mg/kg. In the preferred embodiment, the prophylactically effective amount of monoclonal antibodies is administered as a single, one-time-only dose. In another embodiment, the prophylactically effective amount of monoclonal antibodies is administered as two or more doses over a period of days, weeks, or months (e.g., twice daily for one or two weeks; once daily for one or two weeks; every other day for two weeks; three times per week for two weeks; twice per week for two weeks; once per week for two weeks; twice with the administrations separated by two weeks; once per month; once every two months; once every three months; once every four months; twice per year; or once per year).

As used herein, a “prophylactically effective amount” of the present recombinant viral particles (e.g., recombinant AAV particles) includes, without limitation, (i) from 1×10¹⁰ to 5×10¹⁰ particles (also referred to as “viral genomes” or “vg”) per kg of body weight, from 5×10¹⁰ to 1×10¹¹ particles/kg, from 1×10¹¹ to 5×10¹¹ particles/kg, from 5×10¹¹ to 1×10¹² particles/kg, from 1×10¹² to 5×10¹² particles/kg, from 5×10¹² to 1×10³ particles/kg, from 1×10¹³ to 5×10³ particles/kg, or from 5×10¹³ to 1×10¹⁴ particles/kg; or (ii) 1×10¹⁰ particles/kg, 5×10¹⁰ particles/kg, 1×10¹¹ particles/kg, 5×10¹ particles/kg, 1×10¹² particles/kg, 5×10¹² particles/kg, 1×10¹³ particles/kg, 5×10¹³ particles/kg, or 1×10¹⁴ particles/kg, 5×10¹⁴ particles/kg, or 1×10¹⁵ particles/kg. In the preferred embodiment, the prophylactically effective amount of viral particles is administered as a single, one-time-only dose. In another embodiment, the prophylactically effective amount of viral particles is administered as two or more doses over a period of months or years.

As used herein, a “recombinant AAV (adeno-associated virus) particle”, also referred to as “rAAV particle”, includes, without limitation, an AAV capsid protein (e.g., VP1, VP2 and/or VP3) and a vector comprising a nucleic acid encoding an exogenous protein (e.g., an antibody heavy chain) situated between a pair of AAV inverted terminal repeats in a manner permitting the AAV particle to infect a target cell. Preferably, the recombinant AAV particle is incapable of replication within its target cell. The AAV serotype may be any AAV serotype suitable for use in gene therapy, such as AAV1, AAV2, AAV3, AAV4, AAV5, AAV6, AAV7, AAV8, AAV9, AAV10, AAVrh10, AAV11, AAV12, LK01, LK02 or LK03.

As used herein, “reducing the likelihood” of a human subject's becoming infected with a virus includes, without limitation, reducing such likelihood by at least 10%, at least 20%, at least 30%, at least 40%, at least 50%, at least 60%, at least 70%, at least 80%, at least 90%, at least 95%, or at least 99%. Preferably, reducing the likelihood of a human subject's becoming infected with a virus means preventing the subject from becoming infected with it. Similarly, “reducing the likelihood” of a human subject's becoming symptomatic of a viral infection includes, without limitation, reducing such likelihood by at least 10%, at least 20%, at least 30%, at least 40%, at least 50%, at least 60%, at least 70%, at least 80%, at least 90%, at least 95%, or at least 99%. Preferably, reducing the likelihood of a human subject's becoming symptomatic of a viral infection means preventing the subject from becoming symptomatic.

As used herein, a monoclonal antibody does not “significantly inhibit the ability of hACE2 to cleave” a substrate if (i) it inhibits the ability of intact hACE2 (i.e., full-length hACE2 that includes the extracellular portion, transmembrane portion, and intracellular portion) to cleave the substrate by less than 90%, and/or (ii) it inhibits the ability of the extracellular portion of hACE2 (e.g., recombinant soluble hACE2) to cleave the substrate by less than 90%. In one embodiment, a monoclonal antibody does not significantly inhibit the ability of hACE2 to cleave a substrate if it inhibits the ability of intact hACE2 to cleave the substrate by less than 90%. In another embodiment, a monoclonal antibody does not significantly inhibit the ability of hACE2 to cleave a substrate if it inhibits the ability of the extracellular portion of hACE2 to cleave the substrate by less than 90%. Preferably, a monoclonal antibody does not significantly inhibit the ability of hACE2 (i.e., intact hACE2 and/or its extracellular portion) to cleave a substrate if it inhibits that ability by less than 80%, less than 70%, less than 60%, less than 50%, less than 40%, less than 30%, less than 20%, less than 10%, less than 5%, or less than 1%. By way of example, a monoclonal antibody does not significantly inhibit the ability of hACE2 (i.e., intact hACE2 and/or its extracellular portion) to cleave angiotensin II if it inhibits that ability by less than 90%, less than 80%, less than 70%, less than 60%, less than 50%, less than 40%, less than 30%, less than 20%, less than 10%, less than 5%, or less than 1%. By way of further example, a monoclonal antibody does not significantly inhibit the ability of hACE2 (i.e., intact hACE2 and/or its extracellular portion) to cleave des-Arg-bradykinin if it inhibits that ability by less than 90%, less than 80%, less than 70%, less than 60%, less than 50%, less than 40%, less than 30%, less than 20%, less than 10%, less than 5%, or less than 1%. By way of further example, a monoclonal antibody does not significantly inhibit the ability of hACE2 (i.e., intact hACE2 and/or its extracellular portion) to cleave neurotensin if it inhibits that ability by less than 90%, less than 80%, less than 70%, less than 60%, less than 50%, less than 40%, less than 30%, less than 20%, less than 10%, less than 5%, or less than 1%. By way of further example, a monoclonal antibody does not significantly inhibit the ability of hACE2 (i.e., intact hACE2 and/or its extracellular portion) to cleave kinetensin if it inhibits that ability by less than 90%, less than 80%, less than 70%, less than 60%, less than 50%, less than 40%, less than 30%, less than 20%, less than 10%, less than 5%, or less than 1%. By way of further example, a monoclonal antibody does not significantly inhibit the ability of hACE2 (i.e., intact hACE2 and/or its extracellular portion) to cleave a synthetic MCA-based peptide (preferably Mca-APK(Dnp)) if it inhibits that ability by less than 90%, less than 80%, less than 70%, less than 60%, less than 50%, less than 40%, less than 30%, less than 20%, less than 10%, less than 5%, or less than 1%. By way of further example, a monoclonal antibody does not significantly inhibit the ability of hACE2 (i.e., intact hACE2 and/or its extracellular portion) to cleave apelin-13 if it inhibits that ability by less than 90%, less than 80%, less than 70%, less than 60%, less than 50%, less than 40%, less than 30%, less than 20%, less than 10%, less than 5%, or less than 1%. By way of further example, a monoclonal antibody does not significantly inhibit the ability of hACE2 (i.e., intact hACE2 and/or its extracellular portion) to cleave dynorphin A 1-13 if it inhibits that ability by less than 90%, less than 80%, less than 70%, less than 60%, less than 50%, less than 40%, less than 30%, less than 20%, less than 10%, less than 5%, or less than 1%.

As used herein, a monoclonal antibody “specifically binds” to the extracellular portion of hACE2 if it does at least one of the following: (i) binds to the extracellular portion of hACE2 with an affinity greater than that with which it binds to any other human cell surface protein; or (ii) binds to the extracellular portion of hACE2 with an affinity of at least 500 μM. Preferably, a monoclonal antibody specifically binds to the extracellular portion of hACE2 if it performs both of items (i) and (ii) above. In a preferred embodiment, the monoclonal antibody binds to hACE2 (i.e., to its extracellular portion) with an affinity of at least 100 μM, at least 10 μM, at least 1 μM, at least 500 nM, at least 300 nM, at least 200 nM, at least 100 nM, at least 50 nM, at least 20 nM, at least 10 nM, at least 5 nM, at least 1 nM, at least 0.5 nM, at least 0.1 nM, at least 0.05 nM, or at least 0.01 nM.

As used herein, a monoclonal antibody “specifically inhibits” binding of SARS-CoV-2 to the extracellular portion of hACE2 if it does at least one of the following: (i) reduces such binding more than it reduces the binding of SARS-CoV-2 to any other human cell surface protein; or (ii) reduces such binding by a factor of at least two. Preferably, a monoclonal antibody specifically inhibits binding of SARS-CoV-2 to the extracellular portion of hACE2 if it performs both of items (i) and (ii) above. In a preferred embodiment, the monoclonal antibody reduces binding of SARS-CoV-2 to the extracellular portion of hACE2 by a factor of at least 10, at least 20, at least 50, at least 100, at least 1,000, at least 10,000, at least 100,000, or at least 1,000,000.

As used herein, a monoclonal antibody “specifically inhibits” binding of the SARS-CoV-2 S1 protein receptor binding domain fragment, also referred to as the RBD (e.g., the protein consisting of S amino acid residues 331 to 524) to the extracellular portion of hACE2 if it does at least one of the following: (i) reduces such binding more than it reduces the binding of SARS-CoV-2 S1 protein receptor binding domain fragment to any other human cell surface protein; or (ii) reduces such binding by a factor of at least two. Preferably, a monoclonal antibody specifically inhibits binding of SARS-CoV-2 S1 protein receptor binding domain fragment to the extracellular portion of hACE2 if it performs both of items (i) and (ii) above. In a preferred embodiment, the monoclonal antibody reduces binding of SARS-CoV-2 S1 protein receptor binding domain fragment to the extracellular portion of hACE2 by a factor of at least 10, at least 20, at least 50, at least 100, at least 1,000, at least 10,000, at least 100,000, or at least 1,000,000.

As used herein, a monoclonal antibody “specifically inhibits” the entry of SARS-CoV-2 into hACE2⁺/hTMPRSS2⁺ human cells if it does at least one of the following: (i) reduces such entry more than it reduces the entry of SARS-CoV-2 into hACE2⁻/hTMPRSS2⁻ human cells; or (ii) reduces such entry by a factor of at least two. Preferably, a monoclonal antibody specifically inhibits the entry of SARS-CoV-2 into hACE2⁺/hTMPRSS2⁺ human cells if it performs both of items (i) and (ii) above. In a preferred embodiment, the monoclonal antibody reduces the entry of SARS-CoV-2 into hACE2⁺/hTMPRSS2⁺ human cells by a factor of at least 10, at least 20, at least 50, at least 100, at least 1,000, at least 10,000, at least 100,000, or at least 1,000,000.

As used herein, a monoclonal antibody “specifically inhibits” the entry into hACE2⁺/hTMPRSS2⁺ human cells of a pseudovirus (e.g., a replication-defective SARS-CoV-2 pseudovirus) bearing SARS-CoV-2 S protein if it does at least one of the following: (i) reduces such entry more than it reduces the entry into hACE2⁻/hTMPRSS2⁻ human cells of a pseudovirus bearing SARS-CoV-2 S protein; or (ii) reduces such entry by a factor of at least two. Preferably, a monoclonal antibody specifically inhibits the entry into hACE2⁺/hTMPRSS2⁺ human cells of a pseudovirus bearing SARS-CoV-2 S protein if it performs both of items (i) and (ii) above. In a preferred embodiment, the monoclonal antibody reduces the entry into hACE2⁺/hTMPRSS2⁺ human cells of a pseudovirus bearing SARS-CoV-2 S protein by a factor of at least 10, at least 20, at least 50, at least 100, at least 1,000, at least 10,000, at least 100,000, or at least 1,000,000.

As used herein, the term “subject” includes, without limitation, a mammal such as a human, a non-human primate, a dog, a cat, a horse, a sheep, a goat, a cow, a rabbit, a pig, a hamster, a rat and a mouse. The present methods are envisioned for these non-human embodiments, mutatis mutandis, as they are for human subjects in this invention.

As used herein, a human subject is “symptomatic” of a SARS-CoV-2 infection if the subject shows one or more symptoms known to appear in a SARS-CoV-2-infected human subject after a suitable incubation period. Such symptoms include, without limitation, detectable SARS-CoV-2 in the subject, and those symptoms shown by patients afflicted with COVID-19. COVID-19-related symptoms include, without limitation, fever, cough, shortness of breath, persistent pain or pressure in the chest, new confusion or inability to arouse, and/or bluish lips or face.

As used herein, a “synthetic MCA-based peptide” is a peptide having affixed at one end an MCA (i.e., (7-methoxycoumarin-4-yl)acetyl) moiety and having affixed at the other end a fluorescence-quenching moiety (e.g., 2,4-dinitrophenyl, which is also referred to as DNP or Dnp). Upon its enzymatic cleavage (e.g., by hACE2), the MCA-containing portion of the cleaved peptide is freed from the portion containing the fluorescence-quenching moiety. This, in turn, results in the now unquenched MCA-containing portion emitting a greater detectable fluorescent signal. As such, synthetic MCA-based peptides cleavable by hACE2 can serve as substrates permitting facile fluorescence-based measurement of hACE2 activity and its inhibition. In one embodiment, the synthetic MCA-based peptide comprises the consensus sequence Pro-X_((1-3residues))-Pro-Hydrophobic Residue (e.g., MCA-Pro-X_((1-3residues))-Pro-Hydrophobic Residue-DNP), whereby hACE2 cleaves between the proline and the hydrophobic residue. In another embodiment, the synthetic MCA-based peptide is MCA-YVADAPK-DNP (also referred to as Mca-YVADAPK(Dnp)) (SEQ ID NO: 1). In a preferred embodiment, the synthetic MCA-based peptide is MCA-APK-DNP (also referred to as Mca-APK(Dnp)). In another preferred embodiment, the synthetic MCA-based peptide is the Mc-Ala/Dnp fluorescence resonance energy transfer (FRET) peptide used in the SensoLyte® 390 ACE2 Activity Assay Kit *Fluorimetric* (Anaspec) described below. In yet another preferred embodiment, the synthetic MCA-based peptide is the ACE2 Substrate used in the Angiotensin II Converting Enzyme (ACE2) Activity Assay Kit (Fluorometric) (BioVision) described below.

As used herein, a “therapeutically effective amount” of the present monoclonal antibodies includes, without limitation, (i) 5 mg, 10 mg, 15 mg, 20 mg, 25 mg, 30 mg, 35 mg, 40 mg, 45 mg, 50 mg, 60 mg, 70 mg, 80 mg, 90 mg, 100 mg, 150 mg, 200 mg, 250 mg, 300 mg, 350 mg, 400 mg, 450 mg, or 500 mg; (ii) 5 mg to 20 mg, 20 mg to 50 mg, 50 mg to 100 mg, 100 mg to 200 mg, 200 mg to 300 mg, 300 mg to 400 mg, or 400 mg to 500 mg; (iii) 1 mg/kg, 2 mg/kg, 3 mg/kg, 4 mg/kg, 5 mg/kg, 6 mg/kg, 7 mg/kg, 8 mg/kg, 9 mg/kg, 10 mg/kg, 15 mg/kg, 20 mg/kg, 25 mg/kg, 30 mg/kg, 35 mg/kg, 40 mg/kg, 45 mg/kg, or 50 mg/kg; or (iv) 1 mg/kg to 10 mg/kg, 10 mg/kg to 20 mg/kg, 20 mg/kg to 30 mg/kg, 30 mg/kg to 40 mg/kg, or 40 mg/kg to 50 mg/kg. In the preferred embodiment, the therapeutically effective amount of monoclonal antibodies is administered as a single, one-time-only dose. In another embodiment, the therapeutically effective amount of monoclonal antibodies is administered as two or more doses over a period of days, weeks, or months (e.g., twice daily for one or two weeks; once daily for one or two weeks; every other day for two weeks; three times per week for two weeks; twice per week for two weeks; once per week for two weeks; twice with the administrations separated by two weeks; once per month; once every two months; once every three months; once every four months; twice per year; or once per year).

As used herein, a “therapeutically effective amount” of the subject recombinant viral particles (e.g., recombinant AAV particles) includes, without limitation, (i) from 1×10¹⁰ to 5×10¹⁰ particles (also referred to as “viral genomes” or “vg”) per kg of body weight, from 5×10¹⁰ to 1×10¹¹ particles/kg, from 1×10¹¹ to 5×10¹¹ particles/kg, from 5×10¹¹ to 1×10¹² particles/kg, from 1×10¹² to 5×10¹² particles/kg, from 5×10¹² to 1×10³ particles/kg, from 1×10³ to 5×10³ particles/kg, or from 5×10³ to 1×10¹⁴ particles/kg; or (ii) 1×10¹⁰ particles/kg, 5×10¹⁰ particles/kg, 1×10¹¹ particles/kg, 5×10¹¹ particles/kg, 1×10¹² particles/kg, 5×10¹² particles/kg, 1×10¹³ particles/kg, 5×10¹³ particles/kg, or 1×10¹⁴ particles/kg, 5×10¹⁴ particles/kg, or 1×10¹⁵ particles/kg. In the preferred embodiment, the therapeutically effective amount of viral particles is administered as a single, one-time-only dose. In another embodiment, the therapeutically effective amount of viral particles is administered as two or more doses over a period of months or years.

As used herein, “treating” a subject afflicted with a disorder (e.g., a subject infected with SARS-CoV-2 and symptomatic of that infection) includes, without limitation, (i) slowing, stopping, or reversing the progression of one or more of the disorder's symptoms, (ii) slowing, stopping or reversing the progression of the disorder underlying such symptoms, (iii) reducing or eliminating the likelihood of the symptoms' recurrence, and/or (iv) slowing the progression of, lowering or eliminating the disorder. In the preferred embodiment, treating a subject afflicted with a disorder includes (i) reversing the progression of one or more of the disorder's symptoms, (ii) reversing the progression of the disorder underlying such symptoms, (iii) preventing the symptoms' recurrence, and/or (iv) eliminating the disorder. For a subject infected with SARS-CoV-2 but not symptomatic of that infection, “treating” the subject also includes, without limitation, reducing the likelihood of the subject's becoming symptomatic of the infection, and preferably, preventing the subject from becoming symptomatic of the infection.

Embodiments of the Invention

This invention provides certain anti-hACE2 monoclonal antibodies. It also provides recombinant viral particles (preferably recombinant AAV particles) that, when introduced into a subject, cause the long-term expression of those antibodies. These antibodies and viral particles permit prophylaxis and therapy for SARS-CoV-2 infection. The present recombinant viruses can be any ones suitable for viral-mediated gene therapy including, without limitation, AAV, adenovirus, alphavirus, herpesvirus, retrovirus/lentivirus, or vaccinia virus.

Specifically, this invention provides a monoclonal antibody that (i) specifically binds to the extracellular portion of human angiotensin converting enzyme 2 (hACE2); (ii) specifically inhibits binding of SARS-CoV-2 to the extracellular portion of hACE2 (e.g., binding via the SARS-CoV-2 S1 protein receptor binding domain); and (iii) does not significantly inhibit the ability of hACE2 to cleave angiotensin II and/or a synthetic MCA-based peptide.

This invention also provides a monoclonal antibody that (i) specifically binds to the extracellular portion of human angiotensin converting enzyme 2 (hACE2); (ii) specifically inhibits binding of SARS-CoV-2 to the extracellular portion of hACE2 (e.g., via the SARS-CoV-2 S1 protein receptor binding domain); (iii) specifically inhibits binding of the SARS-CoV-2 S1 protein receptor binding domain fragment (e.g., the protein consisting of S amino acid residues 331 to 524) to the extracellular portion of hACE2; (iv) specifically inhibits the entry of SARS-CoV-2 into hACE2⁺/hTMPRSS2⁺ human cells; (v) specifically inhibits the entry into hACE2⁺/hTMPRSS2⁺ human cells of a pseudovirus (e.g., a replication-defective SARS-CoV-2 pseudovirus) bearing SARS-CoV-2 S protein; and (vi) does not significantly inhibit the ability of hACE2 to cleave angiotensin II and/or a synthetic MCA-based peptide.

This invention further provides a monoclonal antibody that (i) specifically binds to the extracellular portion of human angiotensin converting enzyme 2 (hACE2); (ii) specifically inhibits binding of SARS-CoV-2 to the extracellular portion of hACE2 (e.g., via the SARS-CoV-2 S1 protein receptor binding domain); (iii) specifically inhibits binding of the SARS-CoV-2 S1 protein receptor binding domain fragment (e.g., the protein consisting of S amino acid residues 331 to 524) to the extracellular portion of hACE2; (iv) specifically inhibits the entry of SARS-CoV-2 into hACE2⁺/hTMPRSS2⁺ human cells; and (vi) does not significantly inhibit the ability of hACE2 to cleave angiotensin II and/or a synthetic MCA-based peptide.

This invention still further provides a monoclonal antibody that (i) specifically binds to the extracellular portion of human angiotensin converting enzyme 2 (hACE2); (ii) specifically inhibits binding of SARS-CoV-2 to the extracellular portion of hACE2 (e.g., via the SARS-CoV-2 S1 protein receptor binding domain); (iii) specifically inhibits binding of the SARS-CoV-2 S1 protein receptor binding domain fragment (e.g., the protein consisting of S amino acid residues 331 to 524) to the extracellular portion of hACE2; (v) specifically inhibits the entry into hACE2⁺/hTMPRSS2⁺ human cells of a pseudovirus (e.g., a replication-defective SARS-CoV-2 pseudovirus) bearing SARS-CoV-2 S protein; and (vi) does not significantly inhibit the ability of hACE2 to cleave angiotensin II and/or a synthetic MCA-based peptide.

This invention also provides a monoclonal antibody that (i) specifically binds to the extracellular portion of human angiotensin converting enzyme 2 (hACE2); (ii) specifically inhibits binding of SARS-CoV-2 to the extracellular portion of hACE2 (e.g., via the SARS-CoV-2 S1 protein receptor binding domain); (iv) specifically inhibits the entry of SARS-CoV-2 into hACE2⁺/hTMPRSS2⁺ human cells; and (vi) does not significantly inhibit the ability of hACE2 to cleave angiotensin II and/or a synthetic MCA-based peptide.

This invention further provides a monoclonal antibody that (i) specifically binds to the extracellular portion of human angiotensin converting enzyme 2 (hACE2); (iii) specifically inhibits binding of the SARS-CoV-2 S1 protein receptor binding domain fragment (e.g., the protein consisting of S amino acid residues 331 to 524) to the extracellular portion of hACE2; (v) specifically inhibits the entry into hACE2⁺/hTMPRSS2⁺ human cells of a pseudovirus (e.g., a replication-defective SARS-CoV-2 pseudovirus) bearing SARS-CoV-2 S protein; and (vi) does not significantly inhibit the ability of hACE2 to cleave angiotensin II and/or a synthetic MCA-based peptide.

The above six monoclonal antibodies are referred to herein, collectively and individually, as the present monoclonal antibody. SARS-CoV-2 pseudoviruses and methods of making and using them are known, as are SARS-CoV-2 S1 protein receptor binding domain (RBD) fragments. See, e.g., Shang, et al., and Hoffman, et al. (Cell 2020).

In a preferred embodiment, the present monoclonal antibody does not significantly inhibit the ability of hACE2 to cleave angiotensin II (i.e., to convert angiotensin II to angiotensin-(1-7). This inhibition can be measured according to the methods in the examples section below. A specific example of this embodiment of the invention is a monoclonal antibody that (i) binds to the extracellular portion of hACE2 with an affinity of 50 nM; (ii) reduces binding of SARS-CoV-2 to the extracellular portion of hACE2 by a factor of 100,000; and (iii) inhibits by 20% the ability of hACE2 to cleave angiotensin II.

In a second embodiment, the present monoclonal antibody does not significantly inhibit the ability of hACE2 to cleave des-Arg-bradykinin. This inhibition can be measured according to the methods in the examples section below. A specific example of this embodiment of the invention is a monoclonal antibody that (i) binds to the extracellular portion of hACE2 with an affinity of 50 nM; (ii) reduces binding of SARS-CoV-2 to the extracellular portion of hACE2 by a factor of 100,000; and (iii) inhibits by 20% the ability of hACE2 to cleave des-Arg-bradykinin.

In a third embodiment, the present monoclonal antibody does not significantly inhibit the ability of hACE2 to cleave neurotensin. This inhibition can be measured according to the methods in the examples section below. A specific example of this embodiment of the invention is a monoclonal antibody that (i) binds to the extracellular portion of hACE2 with an affinity of 50 nM; (ii) reduces binding of SARS-CoV-2 to the extracellular portion of hACE2 by a factor of 100,000; and (iii) inhibits by 20% the ability of hACE2 to cleave neurotensin.

In a fourth embodiment, the present monoclonal antibody does not significantly inhibit the ability of hACE2 to cleave kinetensin. This inhibition can be measured according to the methods in the examples section below. A specific example of this embodiment of the invention is a monoclonal antibody that (i) binds to the extracellular portion of hACE2 with an affinity of 50 nM; (ii) reduces binding of SARS-CoV-2 to the extracellular portion of hACE2 by a factor of 100,000; and (iii) inhibits by 20% the ability of hACE2 to cleave kinetensin.

In a fifth embodiment, the present monoclonal antibody does not significantly inhibit the ability of hACE2 to cleave a synthetic MCA-based peptide. This inhibition can be measured according to the methods in the examples section below. A specific example of this embodiment of the invention is a monoclonal antibody that (i) binds to the extracellular portion of hACE2 with an affinity of 50 nM; (ii) reduces binding of SARS-CoV-2 to the extracellular portion of hACE2 by a factor of 100,000; and (iii) inhibits by 20% the ability of hACE2 to cleave a synthetic MCA-based peptide (preferably Mca-APK(Dnp).

In a sixth embodiment, the present monoclonal antibody does not significantly inhibit the ability of hACE2 to cleave apelin-13. This inhibition can be measured according to the methods in the examples section below. A specific example of this embodiment of the invention is a monoclonal antibody that (i) binds to the extracellular portion of hACE2 with an affinity of 50 nM; (ii) reduces binding of SARS-CoV-2 to the extracellular portion of hACE2 by a factor of 100,000; and (iii) inhibits by 20% the ability of hACE2 to cleave apelin-13.

In a seventh embodiment, the present monoclonal antibody does not significantly inhibit the ability of hACE2 to cleave dynorphin A 1-13. This inhibition can be measured according to the methods in the examples section below. A specific example of this embodiment of the invention is a monoclonal antibody that (i) binds to the extracellular portion of hACE2 with an affinity of 50 nM; (ii) reduces binding of SARS-CoV-2 to the extracellular portion of hACE2 by a factor of 100,000; and (iii) inhibits by 20% the ability of hACE2 to cleave dynorphin A 1-13.

In another preferred embodiment of the invention, the present monoclonal antibody binds to an epitope that does not include hACE2 amino acid residues required for normal function. So, in one embodiment, the present monoclonal antibody does not specifically bind to an epitope on hACE2 comprising an amino acid residue selected from the group consisting of Arg273, His345, Pro346, His374, Glu375, His378, Glu402, His505, and Tyr515. The following embodiments are exemplary. (i) The present monoclonal antibody does not specifically bind to an epitope on hACE2 comprising Arg273. (ii) The present monoclonal antibody does not specifically bind to an epitope on hACE2 comprising His345. (iii) The present monoclonal antibody does not specifically bind to an epitope on hACE2 comprising Pro346. (iv) The present monoclonal antibody does not specifically bind to an epitope on hACE2 comprising His374. (v) The present monoclonal antibody does not specifically bind to an epitope on hACE2 comprising Glu375. (vi) The present monoclonal antibody does not specifically bind to an epitope on hACE2 comprising His378. (vii) The present monoclonal antibody does not specifically bind to an epitope on hACE2 comprising Glu402. (viii) The present monoclonal antibody does not specifically bind to an epitope on hACE2 comprising His505. (ix) The present monoclonal antibody does not specifically bind to an epitope on hACE2 comprising Tyr515.

In another embodiment, the present monoclonal antibody does not specifically bind to an epitope on hACE2 comprising an amino acid residue selected from the group consisting of residues 19 to 102, residues 290 to 397, and residues 417 to 430. The following embodiments are exemplary. (i) The present monoclonal antibody does not specifically bind to an epitope on hACE2 comprising an amino acid residue within residues 19 to 102. (ii) The present monoclonal antibody does not specifically bind to an epitope on hACE2 comprising an amino acid residue within residues 290 to 397. (iii) The present monoclonal antibody does not specifically bind to an epitope on hACE2 comprising an amino acid residue within residues 417 to 430.

In a further embodiment, the present monoclonal antibody does not specifically bind to an epitope on hACE2 comprising an amino acid residue selected from the group consisting of residues 103 to 289, residues 398 to 416, and residues 431 to 615. The following embodiments are exemplary. (i) The present monoclonal antibody does not specifically bind to an epitope on hACE2 comprising an amino acid residue within residues 103 to 289. (ii) The present monoclonal antibody does not specifically bind to an epitope on hACE2 comprising an amino acid residue within residues 398 to 416. (iii) The present monoclonal antibody does not specifically bind to an epitope on hACE2 comprising an amino acid residue within residues 431 to 615.

In a further embodiment, the present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue selected from the group consisting of residues 1-18, residues 417-430, and residues 616-740. The following embodiments are exemplary. (i) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 1-5. (ii) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 5-10. (iii) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 10-15. (iv) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 15-18. (v) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 417-420. (vi) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 420-425. (vii) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 425-430. (viii) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 616-620. (ix) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 620-625. (x) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 625-630. (xi) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 630-635. (xii) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 635-640. (xiii) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 640-645. (xiv) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 645-650. (xv) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 650-655. (xvi) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 655-660. (xvii) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 660-665. (xviii) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 665-670. (xix) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 670-675. (xx) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 675-680. (xxi) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 680-685. (xxii) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 685-690. (xxiii) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 690-695. (xxiv) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 695-700. (xxv) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 700-705. (xxvi) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 705-710. (xxvii) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 710-715. (xviii) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 715-720. (xxix) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 720-725. (xxx) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 725-730. (xxxi) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 730-735. (xxxii) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 735-740.

In a further embodiment, the present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue selected from the group consisting of residues 19-416. The following embodiments are exemplary. (i) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 19-25. (ii) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 26-30. (iii) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 31-35. (iv) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 36-40. (v) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 41-45. (vi) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 46-50. (vii) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 51-55. (viii) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 56-60. (ix) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 61-65. (x) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 66-70. (xi) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 71-75. (xii) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 76-80. (xiii) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 81-85. (xiv) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 86-90. (xv) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 91-95. (xvi) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 96-100. (xvii) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 101-105. (xviii) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 106-110. (xix) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 111-115. (xx) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 116-120. (xxi) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 121-125. (xxii) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 126-130. (xxiii) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 131-135. (xxiv) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 136-140. (xxv) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 141-145. (xxvi) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 146-150. (xxvii) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 151-155. (xxviii) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 156-160. (xxix) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 161-165. (xxx) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 166-170. (xxxi) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 171-175. (xxxii) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 176-180. (xxxiii) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 181-185. (xxxiv) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 186-190. (xxxv) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 191-195. (xxxvi) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 196-200. (xxxvii) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 201-205. (xxxviii) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 206-210. (xxxix) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 211-215. (xl) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 216-220. (xli) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 221-225. (xlii) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 226-230. (xliii) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 231-235. (xliv) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 236-240. (xlv) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 241-245. (xlvi) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 246-250. (xlvii) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 251-255. (xlviii) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 256-260. (xlix) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 261-265. (l) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 266-270. (li) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 271-275. (lii) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 276-280. (liii) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 281-285. (liv) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 286-290. (lv) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 291-295. (lvi) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 296-300. (lvii) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 301-305. (lviii) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 306-310. (lix) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 311-315. (lx) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 316-320. (lxi) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 321-325. (lxii) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 326-330. (lxiii) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 331-335. (lxiv) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 336-340. (lxv) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 341-345. (lxvi) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 346-350. (lxvii) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 351-355. (lxviii) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 356-360. (lxix) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 361-365. (lxx) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 366-370. (lxxi) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 371-375. (lxxii) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 376-380. (lxxiii) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 381-385. (lxxiv) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 386-390. (lxxv) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 391-395. (lxxvi) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 396-400. (lxxvii) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 401-405. (lxxviii) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 406-410. (lxxix) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 411-416.

In a further embodiment, the present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue selected from the group consisting of residues 431-615. The following embodiments are exemplary. (i) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 431-435. (ii) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 436-440. (iii) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 441-445. (iv) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 446-450. (v) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 451-455. (vi) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 456-460. (vii) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 461-465. (viii) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 466-470. (ix) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 471-475. (x) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 476-480. (xi) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 481-485. (xii) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 486-490. (xiii) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 491-495. (xiv) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 496-500. (xv) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 501-505. (xvi) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 506-510. (xvii) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 511-515. (xviii) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 516-520. (xix) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 521-525. (xx) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 526-530. (xxi) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 531-535. (xxii) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 536-540. (xxiii) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 541-545. (xxiv) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 546-550. (xxv) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 551-555. (xxvi) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 556-560. (xxvii) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 561-565. (xxviii) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 566-570. (xxix) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 571-575. (xxx) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 576-580. (xxxi) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 581-585. (xxxii) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 586-590. (xxxiii) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 591-595. (xxxiv) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 596-600. (xxxv) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 601-605. (xxxvi) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 606-610. (xxxvii) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue within residues 611-615.

In a further embodiment, the present monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue selected from the group consisting of Ser19, Gln24, Thr27, Phe28, Lys31, His34, Glu35, Glu37, Asp38, Tyr41, Gln42, Leu45, Leu79, Met82, Tyr83, Gln325, Glu329, Asn330, Lys353, Gly354, Asp355, and Arg357. The following embodiments are exemplary. (i) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising residue Ser19. (ii) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising residue Gln24. (iii) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising residue Thr27. (iv) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising residue Phe28. (v) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising residue Lys31. (vi) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising residue His34. (vii) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising residue Glu35. (viii) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising residue Glu37. (ix) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising residue Asp38. (x) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising residue Tyr41. (xi) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising residue Gln42. (xii) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising residue Leu45. (xiii) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising residue Leu79. (xiv) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising residue Met82. (xv) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising residue Tyr83. (xvi) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising residue Gln325. (xvii) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising residue Glu329. (xviii) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising residue Asn330. (xix) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising residue Lys353. (xx) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising residue Gly354. (xxi) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising residue Asp355. (xxii) The present monoclonal antibody specifically binds to an epitope on hACE2 comprising residue Arg357. In a preferred embodiment, the present monoclonal antibody specifically binds to an epitope on hACE2 comprising residue Lys31. In another preferred embodiment, the present monoclonal antibody specifically binds to an epitope on hACE2 comprising residue Lys353.

In yet a further embodiment, the present monoclonal antibody comprises a heavy chain CDR3 comprising an amino acid sequence selected from the group consisting of (i) CAKDRGYSSSWYGGFDYW (SEQ ID NO: 2); (ii) CARHTWWKGAGFFDHW (SEQ ID NO: 3); (iii) CARGTRFLEWSLPLDVW (SEQ ID NO: 4); (iv) CATTENPNPRW (SEQ ID NO: 5); (v) CATTEDPYPRW (SEQ ID NO: 6); (vi) CARASPNTGWHFDHW (SEQ ID NO: 7); (vii) CATTMNPNPRW (SEQ ID NO: 8); and (viii) CAAIAYEEGVYR-WDW (SEQ ID NO: 9). The following embodiments are exemplary. (i) The present monoclonal antibody comprises a heavy chain CDR3 comprising the amino acid sequence CAKDRGYSSSWYGGFDYW (SEQ ID NO: 2). (ii) The present monoclonal antibody comprises a heavy chain CDR3 comprising the amino acid sequence CARHTWWKGAGF-FDHW (SEQ ID NO: 3). (iii) The present monoclonal antibody comprises a heavy chain CDR3 comprising the amino acid sequence CARGTRFLEWSLPLDVW (SEQ ID NO: 4). (iv) The present monoclonal antibody comprises a heavy chain CDR3 comprising the amino acid sequence CATTENPNPRW (SEQ ID NO: 5). (v) The present monoclonal antibody comprises a heavy chain CDR3 comprising the amino acid sequence CATTEDP-YPRW (SEQ ID NO: 6). (vi) The present monoclonal antibody comprises a heavy chain CDR3 comprising the amino acid sequence CARASPNTGWHFDHW (SEQ ID NO: 7). (vii) The present monoclonal antibody comprises a heavy chain CDR3 comprising the amino acid sequence CATTMNPNPRW (SEQ ID NO: 8). (viii) The present monoclonal antibody comprises a heavy chain CDR3 comprising the amino acid sequence CAAIAYEEGVYRWDW (SEQ ID NO: 9).

In a preferred embodiment, the present monoclonal antibody is a humanized monoclonal antibody, and preferably a human monoclonal antibody.

In a first preferred embodiment, the present monoclonal antibody has a low effector function. In a second preferred embodiment, the present monoclonal antibody has a long serum half-life. In a third preferred embodiment, the present monoclonal antibody is an IgG4 antibody. In a fourth preferred embodiment, the present monoclonal antibody comprises a heavy chain modification that inhibits half antibody formation. In a fifth preferred embodiment, the present monoclonal antibody (i) has a low effector function; (ii) has a long serum half-life; (iii) is an IgG4 antibody; and (iv) comprises a heavy chain modification that inhibits half antibody formation.

In a further preferred embodiment, the present monoclonal antibody is an antigen-binding fragment or a single chain antibody.

The following eight embodiments of the present monoclonal antibody are exemplary. In a first embodiment of the invention, the present monoclonal antibody is a humanized or human IgG4 antibody that (i) has the serum half-life-extending mutation combination M252Y/S254T/T256E (YTE) (with numbering according to the EU Index); (ii) has the half antibody formation-inhibiting mutation S228P or K447del, or the mutation combination S228P/K447del (with numbering according to the EU Index); and (iii) has the effector function-lowering L235E mutation (with numbering according to the EU Index).

In a second embodiment of the invention, the present monoclonal antibody is a humanized or human IgG4 antibody that (i) has the serum half-life-extending mutation combination M252Y/S254T/T256E (YTE) (with numbering according to the EU Index); (ii) has the half antibody formation-inhibiting mutation S228P or K447del, or the mutation combination S228P/K447del (with numbering according to the EU Index); and (iii) has one or more of the effector function-lowering mutations L235A, F234A, and G237A (with numbering according to the EU Index).

In a third embodiment of the invention, the present monoclonal antibody is a humanized or human IgG4 antibody that (i) has the serum half-life-extending mutation combination M252Y/S254T/T256E (YTE) (with numbering according to the EU Index); (ii) has the half antibody formation-inhibiting mutation S228P or K447del, or the mutation combination S228P/K447del (with numbering according to the EU Index); and (iii) has the effector function-lowering D265A mutation (with numbering according to the EU Index).

In a fourth embodiment of the invention, the present monoclonal antibody is a humanized or human IgG4 antibody that (i) has the serum half-life-extending mutation combination M252Y/S254T/T256E (YTE) (with numbering according to the EU Index); (ii) has the half antibody formation-inhibiting mutation S228P or K447del, or the mutation combination S228P/K447del (with numbering according to the EU Index); and (iii) has one or more of the effector function-lowering mutations A330R, F243L, and an L328 substitution (with numbering according to the EU Index).

In a fifth embodiment of the invention, the present monoclonal antibody is a humanized or human IgG4 antibody that (i) has the serum half-life-extending mutation combination M252Y/S254T/T256E (YTE) (with numbering according to the EU Index); (ii) has the half antibody formation-inhibiting mutation S228P or K447del, or the mutation combination S228P/K447del (with numbering according to the EU Index); and (iii) has the effector function-lowering IgG2/IgG4 format wherein IgG2 (up to T260) is joined to IgG4 (with numbering according to the EU Index).

In a sixth embodiment of the invention, the present monoclonal antibody is a humanized or human IgG4 antibody that (i) has the serum half-life-extending mutation combination M252Y/S254T/T256E (YTE) (with numbering according to the EU Index); (ii) has the half antibody formation-inhibiting mutation S228P or K447del, or the mutation combination S228P/K447del (with numbering according to the EU Index); and (iii) has the effector function-lowering F243A/V264A mutation combination (with numbering according to the EU Index).

In a seventh embodiment of the invention, the present monoclonal antibody is a humanized or human IgG4 antibody that (i) has the serum half-life-extending mutation combination M252Y/S254T/T256E (YTE) (with numbering according to the EU Index); (ii) has the half antibody formation-inhibiting mutation S228P or K447del, or the mutation combination S228P/K447del (with numbering according to the EU Index); and (iii) has the effector function-lowering E233P/F234A/L235A/G236del/G237A mutation combination (with numbering according to the EU Index).

In an eighth embodiment of the invention, the present monoclonal antibody is a humanized or human IgG4 antibody that (i) has the serum half-life-extending mutation combination M252Y/S254T/T256E (YTE) (with numbering according to the EU Index); (ii) has the half antibody formation-inhibiting mutation S228P or K447del, or the mutation combination S228P/K447del (with numbering according to the EU Index); and (iii) has the effector function-lowering S228P/L235E mutation combination (with numbering according to the EU Index).

In a preferred embodiment of each of the above eight embodiments, the present monoclonal antibody has a “knobs-into-holes” (kih) modification to prevent heavy chain mispairing. In another preferred embodiment of each of the above eight embodiments, the present monoclonal antibody comprises two distinct heavy chains and two identical light chains. In a further preferred embodiment of each of the above eight embodiments wherein the antibody comprises two distinct heavy chains and two identical light chains, one of the heavy chains contains a chimeric Fc form that ablates binding to Protein A via the contact region. This technology, known as FcΔAdp, is described in M. Godar, et al., and A. D. Tustian, et al.

The following additional two embodiments of the present monoclonal antibody are exemplary. In a first embodiment of the invention, the present monoclonal antibody is a humanized IgG4 antibody that (i) has the serum half-life-extending mutation combination M252Y/S254T/T256E (YTE) (with numbering according to the EU Index); (ii) has the half antibody formation-inhibiting mutation S228P or K447del, or the mutation combination S228P/K447del (with numbering according to the EU Index); and (iii) has an effector function-lowering mutation, mutation combination, or alteration, selected from the group consisting of L235E, L235A, F234A, G237A, D265A, A330R, F243L, L328 substitution, F243A/V264A, E233P/F234A/L235A/G236del/G237A, S228P/L235E, and an IgG2/IgG4 format wherein IgG2 (up to T260) is joined to IgG4 (with numbering according to the EU Index).

In a second embodiment of the invention, the present monoclonal antibody is a human IgG4 antibody that (i) has the serum half-life-extending mutation combination M252Y/S254T/T256E (YTE) (with numbering according to the EU Index); (ii) has the half antibody formation-inhibiting mutation S228P or K447del, or the mutation combination S228P/K447del (with numbering according to the EU Index); and (iii) has an effector function-lowering mutation, mutation combination, or alteration, selected from the group consisting of L235E, L235A, F234A, G237A, D265A, A330R, F243L, L328 substitution, F243A/V264A, E233P/F234A/L235A/G236del/G237A, S228P/L235E, and an IgG2/IgG4 format wherein IgG2 (up to T260) is joined to IgG4 (with numbering according to the EU Index).

In a preferred embodiment of each of the above two embodiments, the present monoclonal antibody has a “knobs-into-holes” (kih) modification to prevent heavy chain mispairing. In another preferred embodiment of each of the above two embodiments, the present monoclonal antibody comprises two distinct heavy chains and two identical light chains. In a further preferred embodiment of each of the above two embodiments wherein the antibody comprises two distinct heavy chains and two identical light chains, one of the heavy chains contains a chimeric Fc form that ablates binding to Protein A via the contact region (i.e., FcΔAdp technology).

This invention provides an isolated nucleic acid molecule encoding (i) the complete light chain, or a portion of the light chain, of the present monoclonal antibody, and/or (ii) the complete heavy chain, or a portion of the heavy chain, of the present monoclonal antibody. In one embodiment, the present nucleic acid molecule is a DNA molecule, for example, a cDNA molecule.

This invention further provides a recombinant vector, for example a plasmid or a viral vector, comprising the present nucleic acid molecule operably linked to a promoter of RNA transcription.

This invention still further provides a host vector system comprising one or more of the present vectors in a suitable host cell (e.g., a bacterial cell, an insect cell, a yeast cell, or a mammalian cell such as a hybridoma cell (See, e.g., Chiu and Gilliland, Kohler and Milstein)).

This invention provides a composition comprising (i) the present monoclonal antibody, and (ii) a pharmaceutically acceptable carrier.

This invention also provides a method for reducing the likelihood of a human subject's becoming infected with SARS-CoV-2 comprising administering to the subject a prophylactically effective amount of the present monoclonal antibody. In a preferred embodiment of this method, the subject has been exposed to SARS-CoV-2.

This invention further provides a method for treating a human subject who is infected with SARS-CoV-2 comprising administering to the subject a therapeutically effective amount of the present monoclonal antibody. In one embodiment of this method, the subject is symptomatic of a SARS-CoV-2 infection. In another embodiment, the subject is asymptomatic of a SARS-CoV-2 infection.

This invention provides a recombinant AAV vector comprising a nucleic acid sequence encoding a heavy chain and/or a light chain of the present monoclonal antibody.

In connection with the subject vectors, a nucleic acid sequence “encoding” a protein (e.g., an antibody heavy chain) encodes it operably (i.e., in a manner permitting its expression in a cell infected by a viral particle comprising the vector that contains the nucleic acid sequence). Additionally, the recombinant viral vectors of this invention are not limited to any particular configuration with respect to the exogenous protein-coding sequences. For example, in one embodiment of the subject recombinant AAV vector, a “one vector” approach is used wherein a singular recombinant AAV vector includes nucleic acid sequences encoding both heavy and light antibody chains. In another embodiment, a “two vector” approach is used wherein one recombinant AAV vector includes a nucleic acid sequence encoding the heavy antibody chain, and a second recombinant AAV vector includes a nucleic acid sequence encoding the light antibody chain (See, e.g., S. P. Fuchs, et al. (2016)).

This invention further provides a recombinant AAV particle comprising the present recombinant AAV vector and an AAV capsid protein.

This invention also provides a composition comprising (i) a plurality of the present AAV particles and (ii) a pharmaceutically acceptable carrier.

This invention provides a method for reducing the likelihood of a human subject's becoming infected with SARS-CoV-2 comprising administering to the subject a prophylactically effective number of the present AAV particles.

In one embodiment of the present prophylactic method, the subject has been exposed to SARS-CoV-2. In another embodiment, the subject has not been exposed to SARS-CoV-2.

This invention provides a method for treating a human subject who is infected with SARS-CoV-2 comprising administering to the subject a therapeutically effective number of the present AAV particles.

In one embodiment of the present therapeutic method, the subject is symptomatic of a SARS-CoV-2 infection. In another embodiment, the subject is asymptomatic of a SARS-CoV-2 infection.

This invention further provides a kit comprising, in separate compartments, (a) a diluent and (b) the present monoclonal antibody either as a suspension or in lyophilized form.

Finally, this invention provides a kit comprising, in separate compartments, (a) a diluent and (b) a suspension of a plurality of the present recombinant AAV particles. In one example, the subject kit comprises (i) a single-dose vial containing a concentrated solution of the subject particles (also measured as viral genomes) in a suitable solution (e.g., a solution of sterile water, sodium chloride, sodium phosphate, and Poloxamer 188) and (ii) one or more vials of suitable diluent (e.g., a solution of sterile water, sodium chloride, sodium phosphate, and Poloxamer 188).

The present vectors, particles, and methods are envisioned for suitable recombinant non-AVV viruses (e.g., lentivirus, adenovirus, alphavirus, herpesvirus, or vaccinia virus), mutatis mutandis, as they are for recombinant AAV viruses in this invention.

This invention will be better understood by reference to the examples which follow, but those skilled in the art will readily appreciate that the specific examples detailed are only illustrative of the invention as described more fully in the claims which follow thereafter.

EXAMPLES Example 1—BioVision Assay Kit for ACE2 Function

BioVision, Inc. sells the Angiotensin II Converting Enzyme (ACE2) Activity Assay Kit (Fluorometric) (https://www.biovision.com/angiotensin-ii-converting-enzyme-ace2-activity-assay-kit-fluorometric.html). This kit can be used to measure the degree to which an antibody inhibits the ability of hACE2 to cleave angiotensin II.

BioVision provides the following background information regarding its test kit, which has been edited here. Angiotensin II converting enzyme (ACE2), a zinc-based metalloprotease, is part of the renin-angiotensin system (RAS) that controls the regulation of blood pressure by cleaving the C-terminal amino acid residue of Angiotensin II to convert it into Angiotensin 1-7. ACE2 is a receptor of human coronaviruses, such as SARS and HCoV-NL63. It is expressed on the vascular endothelial cells of lung, kidney, and heart. ACE2 is a potential therapeutic target for cardiovascular and coronavirus-induced diseases. BioVision's kit will aid research in this field. It utilizes the ability of an active ACE2 to cleave a synthetic MCA-based peptide substrate to release a free fluorophore. The released MCA can be easily quantified using a fluorescence microplate reader. BioVision also provides an ACE2-specific inhibitor that can differentiate the ACE2 activity from other proteolytic activity. This kit can detect as low as 0.4 mU, is simple, and can be used in a high-throughput format.

BioVision's kit has the following specifications: (i) Cat #—K897-100; (ii) Size—100 assays; (iii) Detection Method—Fluorometric (Ex/Em=320/420 nm); (iv) Species Reactivity—Mammalian; (v) Applications—Detection of ACE2 activity in tissue/cell lysates and enzyme preparations; (vi) Features & Benefits—Simple one-step reaction/Takes only 1-2 hrs/Non-radiometric fluorescent detection/HTP adaptable; (vii) Kit Components—ACE2 Assay Buffer/ACE2 Dilution Buffer, and ACE2 Lysis Buffer/ACE2 Positive Control, ACE2 Substrate, ACE2 Inhibitor (22 mM), and MCA-Standard (1 mM); (viii) Storage Conditions—−20° C.; and (ix) Shipping Conditions—Gel Pack.

Example 2—SensoLyte Assay Kit for ACE2 Function

Anaspec sells the SensoLyte® 390 ACE2 Activity Assay Kit *Fluorimetric* (“SensoLyte kit”) (https://www.anaspec.com/products/product.asp?id=43987). This kit can be used to measure the degree to which an antibody inhibits the ability of hACE2 to cleave angiotensin II.

Anaspec provides the following information regarding its SensoLyte test kit, which has been edited here. The kit provides a convenient assay for high throughput screening of ACE2 enzyme inhibitors and inducers using a Mc-Ala/Dnp fluorescence resonance energy transfer (FRET) peptide. In the FRET peptide, Dnp quenches the fluorescence of Mc-Ala. Upon cleavage into two separate fragments by ACE2, the fluorescence of Mc-Ala is recovered, and can be monitored at excitation/emission=330/390 nm. This assay can detect the activity of sub-nanogram levels of ACE2. Assays are performed in a convenient 96-well microplate format.

The Sensolyte kit also has the following specifications: (i) Cat #—AS-72086; (ii) Size—100 assays; (iii) Storage Conditions—−20° C.

Example 3—Angiotensin II-Based Mass Spectrometry Assay for hACE2 Function

This method (the “mass spectrometry assay”) can be used to quantitatively measure hACE2 activity using mass spectrometry. In particular, it can be used to measure the degree to which an antibody inhibits the ability of hACE2 to cleave angiotensin II, as well as other substrates. The method is adapted from the ACE2 assay described in Donoghue, et al.

Enzymatic reactions are performed in 15 μl. To each tube at room temperature is added 10 μl of buffer (10 mmol/I Tris, pH 7.0) with or without hACE2. The hACE2 used in this method is recombinant soluble hACE2 prepared according to Donoghue, et al. Five microliters of purified angiotensin II (Sigma) are added to each tube for a final concentration of 5 μmol/l. (This mass spectrometry assay can also employ peptide substrates other than angiotensin II (e.g., des-Arg-bradykinin, neurotensin, kinetensin, apelin-13, and dynorphin A 1-13).) Lisinopril or captopril (Sigma) is added to some reactions at final concentrations of 6.6 μmol/l. Neither lisinopril nor captopril inhibits hACE2 activity, and these compounds are thus useful as controls to ensure that the angiotensin II cleavage measured is due to hACE2 activity. For reactions and control experiments, the tubes are incubated at 37° C. for 30 minutes. A portion (1 μl) of each reaction is quenched by the addition of 1 μl of a low-pH MALDI matrix compound (10 g/L α-cyano-4 hydroxycinnamic acid in a 1:1 mixture of acetonitrile and water). One microliter of the resulting solution is applied to the surface of a MALDI plate. The plate is then air-dried and inserted into the sample introduction port of the Voyager Elite biospectrometry MALDI time-of-flight (TOF) mass spectrometer (PerSeptive Biosystems). The resulting signal is digitized at a frequency of 1 GHz and accumulated for 64 scans. Purified conditioned medium from empty vector transfections is used to control individual experiments for variability in extent of substrate conversion to product. For tandem mass spectrometry sequencing, a hybrid quadrupole time-of-flight mass spectrometer (Q-TOF-MS) (Micromass UK Limited) equipped with an orthogonal electrospray source (Z-spray) is used. The quadrupole is set up to pass precursor ions of selected m/z to the hexapole collision cell (Q2), and product ion spectra are acquired with the TOF analyzer. Argon is introduced into the Q2 with a collision energy of 35 eV and cone energy of 25 V.

Example 4—Angiotensin II-Based HPLC Assay for hACE2 Function

This method (the “HPLC assay”) can be used to quantitatively measure hACE2 activity using HPLC. In particular, it can be used to measure the degree to which an antibody inhibits the ability of hACE2 to cleave angiotensin II, as well as other substrates. The method is adapted from the “ACEH” assay described in Tipnis, et al.

Protein and Enzymatic Assays. Protein concentrations are determined using the bicinchoninic acid assay (Smith, et al.) with bovine serum albumin as a standard. Assays for hACE2 activity are carried out in a total volume of 100 μl, containing 100 mM Tris-HCl, pH 7.4, 20 μg of protein and 100 μM angiotensin II as a substrate. (This HPLC assay can also employ peptide substrates other than angiotensin II (e.g., des-Arg-bradykinin, neurotensin, and kinetensin, apelin-13, and dynorphin A 1-13).) Where appropriate, inhibitors are added to give final concentrations of 10 μM lisinopril, 10 μM captopril, 10 μM enalaprilat, 100 μM benzyl succinate, or 10 mM EDTA. EDTA inhibits hACE2 activity, but none of lisinopril, captopril, enalaprilat, and benzyl succinate (a carboxypeptidase A inhibitor) inhibits hACE2 activity. These compounds are thus useful as controls to ensure that the angiotensin II cleavage measured is due to hACE2 activity. Reactions are carried out at 37° C., for 2 hours and stopped by heating to 1000° C. for 5 minutes followed by centrifugation at 11,600×g for 10 minutes. Carboxypeptidase A assays are carried out at room temperature for 30 minutes, using 0.1 units of enzyme per assay.

HPLC Analysis of Cleavage Products. Peptide hydrolysis products are separated using reverse-phase HPLC (μBondapak C-18 reverse phase column, Waters) with a UV detector set at 214 nm. All separations are carried out at room temperature, with a flow rate of 1.5 ml/min. Mobile phase A consists of 0.08% (v/v) phosphoric acid and mobile phase B consists of 40% (v/v) acetonitrile in 0.08% (v/v) phosphoric acid. A linear solvent gradient of 11% B to 100% B over 15 minutes with five minutes at final conditions, and eight minute re-equilibration is used. The product from angiotensin II is collected and analyzed by matrix-assisted laser desorption ionization/time-of-flight mass spectrometry.

Example 5—Measuring Interaction of Soluble RBD Protein with Soluble hACE2

In a preferred embodiment of this invention, measuring the interaction of soluble RBD protein (a proxy for SARS-CoV-2) with soluble hACE2 (a proxy for the extracellular portion of hACE2) can be used to indirectly measure (i) the binding of a monoclonal antibody to the extracellular portion of hACE2, and (ii) a monoclonal antibody's ability to inhibit binding of SARS-CoV-2 to the extracellular portion of hACE2.

The following method for analyzing hACE2-binding inhibition is taken from Suryadevara, et al. Wells of 384-well microtiter plates are coated with 1 μg/mL purified recombinant SARS-CoV-2 S2P_(ecto) protein at 4° C. overnight. Plates are blocked with 2% non-fat dry milk and 2% normal goat serum in DPBS-T for 1 hour. For screening assays, purified monoclonal antibodies are diluted two-fold in blocking buffer starting from 10 μg/mL in triplicate, added to the wells (20 μL per well) and incubated for 1 hour at ambient temperature. Recombinant hACE2 with a C-terminal Flag tag peptide is added to wells at 2 μg/mL in a 5 μL per well volume (final 0.4 μg/mL concentration of hACE2) without washing of antibody and then incubated for 40 minutes at ambient temperature. Plates are washed and bound hACE2 is detected using HRP-conjugated anti-Flag antibody (Sigma-Aldrich, cat. A8592, lot SLBV3799, 1:5,000 dilution) and TMB substrate. ACE2 binding without antibody serves as a control. The signal obtained for binding of the human ACE2 in the presence of each dilution of tested antibody is expressed as a percentage of the human ACE2 binding without antibody after subtracting the background signal. For dose-response assays, serial dilutions of purified monoclonal antibodies are applied to the wells in triplicate, and monoclonal antibody binding is detected as detailed above. IC50 values for inhibition by monoclonal antibody of S2P_(ecto) protein binding to human ACE2 are determined after log transformation of antibody concentration using sigmoidal dose-response nonlinear regression analysis.

The reagents used in this example can be made according to this reference and/or purchased commercially (e.g., from LakePharma, Inc., Worcester, Mass.). In addition, related kits are commercially available. For example, (i) a SARS-CoV-2 Spike-ACE2 Interaction Inhibitor Screening Assay Kit is available from Cayman Chemical (Ann Arbor, Mich.); and (ii) a SARS-CoV-2 Spike:ACE2 Inhibitor Screening Assay Kit, an ACE2 Inhibitor Screening Assay Kit, and a Spike RBD (SARS-CoV-2): ACE2 Inhibitor Screening Assay Kit are all available from BPS Bioscience (San Diego, Calif.).

Example 6—Antibody Expression Cassettes

FIG. 4 shows a schematic diagram of an expression cassette for use in the subject rAAV vector encoding the present anti-hACE2 monoclonal antibody. The cassette has the following structure: 5′ITR-CAG-Antibody Heavy Chain-Furin F2A-Antibody Light Chain-SV40 polyA-3′ITR.

These cassette components include a CMV enhancer/chicken beta-actin promoter and intron (or CAG); an SV40 polyadenylation signal (or SV40 polyA); heavy and light chains of the antibody; and a furin F2A self-processing peptide cleavage site. The expression cassette is flanked by AAV serotype 2 inverted terminal repeats (ITR). In the cassette-containing bicistronic single-stranded AAV (ssAAV) vector, both the heavy and light chains are expressed from one open reading frame using a F2A self-processing peptide from FMD. The furin cleavage sequence “RKRR” (SEQ ID NO: 10) for the cellular protease furin is added for removal of amino acids left on the heavy chain C-terminus following F2A self-processing. In one embodiment of this invention, the subject rAAV vectors possess introns, and in another embodiment, they do not. Abbreviations: CMV, cytomegalovirus; SV40, simian virus 40; and FMD, foot-in-mouth disease virus.

Example 7—rAAV Production

The subject rAAVs can be produced according to known methods. For instance, in one such method, HEK-293 cells are transfected with a select rAAV vector plasmid and two helper plasmids to allow generation of infectious AAV particles. After harvesting transfected cells and cell culture supernatant, rAAV is purified by three sequential CsCl centrifugation steps. Vector genome number is assessed by Real-Time PCR, and the purity of the preparation is verified by electron microscopy and silver-stained SDS-PAGE (Mueller, et al.).

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1. A monoclonal antibody that (i) specifically binds to the extracellular portion of human angiotensin converting enzyme 2 (hACE2); (ii) specifically inhibits binding of SARS-CoV-2 to the extracellular portion of hACE2; and (iii) does not significantly inhibit the ability of hACE2 to cleave angiotensin II and/or a synthetic MCA-based peptide.
 2. The monoclonal antibody of claim 1, wherein the monoclonal antibody does not significantly inhibit the ability of hACE2 to cleave angiotensin II.
 3. The monoclonal antibody of claim 1, wherein the monoclonal antibody does not significantly inhibit the ability of hACE2 to cleave a synthetic MCA-based peptide.
 4. The monoclonal antibody of claim 1, wherein the monoclonal antibody does not specifically bind to an epitope on hACE2 comprising an amino acid residue selected from the group consisting of Arg273, His345, Pro346, His374, Glu375, His378, Glu402, His505, and Tyr515.
 5. The monoclonal antibody of claim 1, wherein the monoclonal antibody does not specifically bind to an epitope on hACE2 comprising an amino acid residue selected from the group consisting of residues 19 to 102, residues 290 to 397, and residues 417 to
 430. 6. The monoclonal antibody of claim 1, wherein the monoclonal antibody does not specifically bind to an epitope on hACE2 comprising an amino acid residue selected from the group consisting of residues 103 to 289, residues 398 to 416, and residues 431 to
 615. 7. The monoclonal antibody of claim 1, wherein the monoclonal antibody specifically binds to an epitope on hACE2 comprising an amino acid residue selected from the group consisting of Ser19, Gln24, Thr27, Phe28, Lys31, His34, Glu35, Glu37, Asp38, Tyr41, Gln42, Leu45, Leu79, Met82, Tyr83, Gln325, Glu329, Asn330, Lys353, Gly354, Asp355, and Arg357.
 8. The monoclonal antibody of claim 1, wherein the monoclonal antibody comprises a heavy chain CDR3 comprising an amino acid sequence selected from the group consisting of (i) CAKDRGYSSSWYG-GFDYW; (ii) CARHTWWKGAGFFDHW; (iii) CARGTRFLEWSLPLDVW; (iv) CATTENPNPRW; (v) CATTEDPYPRW; (vi) CARASPNTGWHFDHW; (vii) CATTMNPNPRW; and (viii) CAAIAYEEGVYRWDW.
 9. The monoclonal antibody of claim 1, wherein the monoclonal antibody is a humanized monoclonal antibody.
 10. The monoclonal antibody of claim 1, wherein the monoclonal antibody is a human monoclonal antibody.
 11. The monoclonal antibody of claim 1, wherein the antibody is an antigen-binding fragment or a single chain antibody.
 12. An isolated nucleic acid molecule encoding (i) the light chain of the monoclonal antibody of claim 1, and/or (ii) the heavy chain of the monoclonal antibody of claim
 1. 13. A recombinant vector comprising the nucleotide sequence of the nucleic acid molecule of claim 12 operably linked to a promoter of RNA transcription.
 14. A composition comprising (i) the monoclonal antibody of claim 1, and (ii) a pharmaceutically acceptable carrier.
 15. A method for reducing the likelihood of a human subject's becoming infected with SARS-CoV-2 comprising administering to the subject a prophylactically effective amount of the monoclonal antibody of claim
 1. 16. The method of claim 15, wherein the subject has been exposed to SARS-CoV-2.
 17. A method for treating a human subject who is infected with SARS-CoV-2 comprising administering to the subject a therapeutically effective amount of the monoclonal antibody of claim
 1. 18. The method of claim 17, wherein the subject is symptomatic of a SARS-CoV-2 infection.
 19. The method of claim 17, wherein the subject is asymptomatic of a SARS-CoV-2 infection.
 20. A recombinant AAV vector comprising a nucleic acid sequence encoding a heavy chain and/or a light chain of the monoclonal antibody of claim
 1. 21. The recombinant AAV vector of claim 20, wherein the nucleic acid sequence encodes a heavy chain and a light chain.
 22. A recombinant AAV particle comprising the recombinant AAV vector of claim
 20. 23. A composition comprising (i) a plurality of the AAV particles of claim 22 and (ii) a pharmaceutically acceptable carrier.
 24. A method for reducing the likelihood of a human subject's becoming infected with SARS-CoV-2 comprising administering to the subject a prophylactically effective number of the AAV particles of claim
 22. 25. The method of claim 24, wherein the subject has been exposed to SARS-CoV-2.
 26. A method for treating a human subject who is infected with SARS-CoV-2 comprising administering to the subject a therapeutically effective number of the AAV particles of claim
 22. 27. The method of claim 26, wherein the subject is symptomatic of a SARS-CoV-2 infection.
 28. The method of claim 26, wherein the subject is asymptomatic of a SARS-CoV-2 infection.
 29. A kit comprising, in separate compartments, (a) a diluent and (b) a suspension of the monoclonal antibody of claim
 1. 30. A kit comprising, in separate compartments, (a) a diluent and (b) the monoclonal antibody of claim 1 in lyophilized form.
 31. A kit comprising, in separate compartments, (a) a diluent and (b) a suspension of a plurality of the recombinant AAV particles of claim
 22. 